HHKH Y DUPC - K Y NIEM 50 HAM HSAY TRUYeM T H O H G T R U O M G CAO D A N G Y T H A I NGUYtM (1966-2016|
XAC BINH MUC D O NHAY CAM Vffl KHANG SINH CUA VI KHUAN SINH
B- LACTAMASE PHO RONG (ESBL: EXTENDED SPECTRUM B-LACTAMA
TAI BENH VIEN VIET BU'C, NAM 201S-2016
H i Thi Nguyet Minh*, Bui Huy Tilng*, Nguyin Thanh Huylni
TdMTAT
Xac djnh ty le nhay cam vdi khang sinh tft
115 chiing vi khuan sinh ESBL dugc phan lap
dugc tu 115 b?nh nhan t^i khoa Vi sinh, B?nh
vifn Vi?t Diic ttong 6 Uiang (tft thing 11/2015
den 4/2016). cho kit qua co 5 lo9i vi khudn sinh
ESBL nhimg chii ylu la: E. coll 73%, kiebsiella
22%, Proteus 4%. Ket qua nhjn dugc la: Ty le
nh?y cam ciia E. coil vi, Klebsiella vdi
cefoperazon -i- sulbactam (86,9%; 88%);
ticattillin + clavulanate (69%; 40%); amikacin
(65,4%; 40%); levofioxacin (51,2%; 36%);
cefoxitin (54,8%; 72%). E. coll vi Klebsiella
khing vdi khang sinh cefuroxim, ceftriaxon,
cefotaxim, ceflazidim (100%). Ning dg uc che
toi thieu (MIC) ertapenem vi imipenem ciia 33
chiing vi khuan sinh ESBL: vi khuin sinh ESBL
khing vdi imipenem (> 4 pg/mL) vdi 12,1% vd
9,1%, khing vdi eruipenem (2 pg/ml).
Tir khia: vi khudn sinh p- lactamase
SUMMARY
DETERMINATION OF SENSITIVITY
TO ANTIBIOTICS OF BACTERIA
EXTENDED SPECTRUM B-
LACTAMASE BACTERIA (ESBL-
EXTENDED SPECTRUM B-
LACTAMASE) IN VIETDUC
' Truing Cao ding Y ti Hi Npi
Chiu trtch ahiSm chinh: Ha Thj NguySt Minh
Email: hanguyetminh@gmail.com
Ngay nhjin bii: 7.9.2016
Ngay phin bija khoa hpc: I l.I l 2016
Ngay duyet bai:29.11.2016
N8;uyen Thanh Thuy*, Vu Van Hii
UNIVESITY HOSPITAL VIETNAM,;
2015-2016
Determining the percentage of antibii
sensitivity from 115 stt-ains ESBL isolated .
115 patients at the Department of Microbiol
Vietnam-Germany Hospital for 6 mom
(11/2015 to 4/2016), resulting in the 5
bacteria which are mainly: E. coli majority
(73%), kiebsiella (22%), Proletis fl
Citrobacler (0,9%), Enlerobacler /D,9 %).
received results revealed that: E. coli
Klebsiella were sensitive to cefoperazon
sulbactam (86.9%; 88%); Ticarcillin
clavulanate (69%; 40%); amikacin (65.4%; 40»li
levofioxacin (51.2%; 36%); cefoxitin (54.8%* II
72%). E. coli and Klebsiella were resistam lo
cefuroxlme, ceftriaxon, cefotaxime, Ceftazi*
(100%). The minimum inhibitoiy concenlratiM
(MIC) of ertapenem and imipenem 33 slraim II
ESBL bacteria: MIC of resistant to imipenemfi
4 ng/mL) with 12,1% and ertapenem (2 ng'nl.l
with 9.1%.
I.OJiTV^NB^
Nhilm khuin do cdc vi khuin siiiii
enzym P- lactamase pho r^ng (ESBL;
Extended Spectrum fi-laclamase) li vi khiA
gram dm v4 thudng gjp Id Escherichia *
Klebsiella pneumoniae. Pseudm
aeruglnsa... Vi khudn sinh ESBL sS »,.
todn b | cdc penicillin, cephalosporin »
a2lreonam. Hon nfta chung cdn cd khd im
dl khtog chio vdi nhilu nhdm khtog silll
khde nhft aminoglycoside, fluoroqumolon^
l^Jt
Y HOC VIST NAM TAP 449-THAHG 1 2 . S 6 PAC BIET-2016

%ieu nay dd gay rdt nhilu khd khto cho dilu 2.4. Phirang phdp nghien ciru ^^M
m do vice lua chgn khtog sinh bi thu hep. 2.4.1.Thiet kl; Sut dung phuong
phuang ^^^M ^_
IhOng bgnh nhto nhilm khudn do vi khuin nghien cuu md ta cit ngang tai thdi dilm
inh ESBL cd benh cdnh Idm stog thudng nghien cftu, phto lap duoc vi khuin sinh
bejing, ty IS ttr vong cao. Trudc thuc ttang ESBL.
.ViiifSn, nhdm nghiSn cftu da tiln hdnh di tdi tai 2.4J. Co mlu vd ky thudt chgn mau:
)gnh vign Viet Dftc, la mgt benh viSn diu -115 chtog vi khuin smh ESBL phto ldp
\giiih ve ngogi khoa ttong c4 nudc, sd dugc tai khoa Vi suih - Benh vien Viet Due.
j.ugng blnh nhto cung nhu benh cdnh Idm - Ky thuat chon mail: 1 r5>:htag vi khuin
liii,tog rat da dang. Htog ngay thgc bien rit sinh ESBL phto lap dugc tai khoa Vi sinh -
iiyhilu cdc logi phau thugt cho ngudi benh. BSnh vito Vilt Due, tft 11/2015 din 4/2016.
ir 13Snh vi|n da dp dgng rit nhilu tiln bg kiioa 2.4.3. Phuang phdp nghien cftu
kiigc ky thugt mdi, ctog vdi su ra ddi cua - Phuang phap Idy benh phim, nudi cay,
S h i l u khtog sinh thi he mdi dd dem lai dinh danh vi khudn duoc thyc hien theo ky
J ^ u i u k i t ^ B k h d quan trong diiu Ui v4 du thuat thudng quy cua khoa vi sinh, benh vien
I P ^ D ^ ^ K h u i n bSnh viSn ndi chung v4 Viet Dftc, theo hudng dan cfta CLSI 2015.
j^;4c nhiim khuan do vi khudn gram dm ndi - Xdc dinh vi khudn sinh ESBL: bdng
-jiSng nhit la cdc vi khuin sinh ESBL. Tuy phuong phdp dia kit hgp theo CLSI 2015.
(wnhiSn, ty lg vi khuin sinh ESBL vd khd ntog - Khtog sinh dd; Theo CLSL ndm 2015
It dl khtog vdi khtog sinh cua cac vi khudn -J- Ky thugt khoanh gidy khtog sinh
:«i4y ctog thay ddi v4 gia ttog theo thdi gian. khuleh tto ttSn thgch cua Kirby Bauer cdi
i: tien.
'll. efii TUpNG VA PHlf am PHAP NGHIEN cCru -*- Kf thugt xac djnh MIC.
2.1. Dii lirptng nghien ciru: 115 Chtag 2.5. Xft ij so lieu: Theo tets thing kl, ty
"vi khuin sinh ESBL phto Igp dugc tai khoa 1? % va phim mim SPSS 20.
vi sinh - B$nh vien ViSt Bftc, ttong thdi gian 2.6. Y d4c trong nghiSn cftu: Trung
tft thtog 11/2015 din 4/2016 thyc khach quan ttong nghiSn cftu
2.2. Bia aim, thii gian nghien ciru ; 2.7. Sai so: Trong qui trinh nghiSn cftu
Khoa vi sinh - B^nh vign ViSt Buc cd the gdp mdt sl sai sd sau:
2.3. V0I lifu, phmmg lifn nghien ctru - Tuto thu dtog chi dinh cay khuin cua
• Mdi ttudng, sinh pham cua htog Bio- Bac sy, dtog kJ thudt vd thdi dilm lay mau
Merieux. bgnh phim.
•1- Khoanh giay khtog sinh cic loai - Tuto thii ky thugt nudi cay, djnh danh,
•I- Chtog vi khuin chuin qude ti: E. coli phdt Wen ESBL va ldm khtog sinh dd.
ACTT 11775 vd K. pneumoniae ATCC 2.8. Han che sai s l
700603. Lua chgn thdnh viln cd dii ntog Iftc, kinh
- Mgt so thilt bi dung cu phdng thi nghigm vd ttach nhiem khi tham gia.
nghiim vd dgng cg tieu hao: dyng cu chuyen Thyc hien dtog qui ninh nudi edy, phto
dyng cua phdng xSt nghigm lap v4 Idm khtog sinh dl.
 HNKH Y DUOC - K Y N r a i 50 HAM NGAY T R U Y £ N T H 6 N G T R L / P N G C A O B A N G Y THAI NGUYEN (1966-2016)

III. KFT QUA VA BAN LUAN

3.1Sirphdn bd cua vi khudn sinh ESBL
3.1.1. Sy phSn b6 cua vi khuan sinh ESBL
Bang 3.1. Phan bo vi lihuan sinh ESBL
Vi khuan n Ty IS % 1
£ coli 84 73 J
Klebsiella 25 21,7 fl
Proteus 4 3.5 i
Citrobacler 1 0.9 ,1
Enlerobacler 1 0,9 J
Tong s l 115 100% 1
Tft btog 3.1. cdsy phto bdvikhuto sinh 12,0%, Enlerobacler spp I0,7%[2], N^
ESBL chu ylu Id thugc hg tiyc khuto dudng cftu cfta cdc tdc gid trln thi gidi thi chij
mgt, ntlng dd E. coli chilm da s6 73%, ring cd sy khde nhau vi ty Ig sinh ESBL giBi
Klebsiella 22%, Proteus 4%, Citrobacler cdc khu vuc nghien curu, toy nhiSn lodi li
0,9%, Enlerobacler 0,9 %. Troiig nghiin cftu khuin chilm uu thi dugc ghi nhta van ia£
cfta chtog tdi khi xem xit vl cic lodi coli v4 Klebsiella. Dtog luu y 14 ty 1§ niy
khudn sinh ESBL thi E. coll sinh ESBL dang ttog rdt nhanh theo tftng ndm, thw
chilm ty 1? cao nhdt, KSt qua ndy ctog phu nghiSn cftu cfta Ha Thu Vto tgi bgnh vijn
hgp vdi nghien cftu cfta da s l cdc tdc gid diu 103 trong 3 nam 2010; 2011; 2013 ting
nhto thiy E. coll vk Klebsiella 14 2 loii toong ftng tft 25% ; 37,8%; 39,4%[5).
chiem ty lg cao nhdt ttong tdng so vi khudn Trong nghiSn cftu cua chftng tdi c6 ty If
sinh ESBL. E. coli cao hon so vdi mgt sd nghiin nghi^r
^ Theo nghiSn cftu cua Pham Thj Thu cuu ttong nudc, cd thi do chtog tdi thyc lifn
Hong Igi b^nh vi^n Binh Dto (2012) cho tgi bgnh vi§n ngogi khoa toyln culi, noi tifl
thdy: vi khuin sinh ESBL thudng g}p Id chung nhilu bgnh nhto ntog, cd nhilu can
Escherichia coll (37,65%), Enlerobacler thigp.
(32,73%), Klebsiella (33,33%)[3], Ttin Do Ndi chung cd kit qud tuong ding giQa
Htag vi cs t^i Blnh vito Da khoa Cto Tho cac b$nh vito vi ty lg sinh ESBL cua E coli
(2012): Cd 5 logi ttgc khuin Onun dm sinh vd Klebsiella chilm chft yiu. Hiu hit cic tic
ESBL li Escherichia call 34,5%, Klebsiella gid diu nhan mgnh vl sy thich nghi ciia cit
pneumoniae 17,8%, Proleus mirabilis vi khuan ndy trong mdi tnidng b^nh vign.

3.1.2. Phan b l vi khuin sinh ESBL theo khoa dieu trj

Bing 3.2, Phin bj vi khuin sinh ESBL Iheo khoa diiu tri
I
 Y HQC V^NAMTAP 449-THANG 12-soDAC Bl£T-2016

Phau thuat thgn kinh 5,2

Pblu thuat nhilm khuan 5,2
Cac khoa khac 12,1
Tong so 100%
J Ty le yi khuan smh ESBL ttong nghito Paterson
raierson (2005)
(zuuj) vi khuin
Khuto sinh
smh ESBL thudng
jj-;nu sy phan bd vi khuto smh ESBL gap chft tap chung d cdc don vi chdm sdc ddc biet vd
rpveu d khoa chto thuong, hdi sftc cap cftu, Idy lan din cac khoa khac ttong btah vienld]
^hauthuat gan mat, phto thudt tilt nigu. Nhu vay, kit qua vi khuin smh ESBL
i r - '™° J^S^y™ •"-! Nggc Anh tai bgnh ttong nghita cuu nay ctog nhu cac nghiSn
^vign Nhi dong 2 (2006) ty lg sinh ESBL phto cftu ttong v4 ngodi nudc diu phto lap dugc

^hiet (22,47%), khoa hot sue (I9,2%)[l].Thco thdigianndm vita Ito ngdy...

3.1.3, PhSn bo vi khuin sinh ESBL theo benh phim.

Bing 3.3. Phin hi vi khuin sinh ESBL Iheo binh phim
Blnh phim ' '

rong nghito cftu bgnh pham phto lgp thuong- vit m l (26,8%) va mdu (21 3%)r51
"dugc nhilu vi khuto sinh ESBL la dich d Theo Nguyin Thj Ngoc Anh tai b^'nh viSn
•bimg - dich mgt (35,6%). dich cac logi vit Nhi ding 2 (2006) bgnh phdm phto Ito dugc
m l - m u - d i c h vet mo (31,3%), Djch phi qud nhilu vi khudn sinh ESBL ESBl. la
IS nudc
n„A. ,is„
tilu
- ddm (20%), nudc tilu (8,7%) v4 dich khde (27,25%). tilp theo la ddm (16,03%), mu
f('t,4%). (20,2%)[I].
,' Theo nghiSn cftu cua H4 Thu Vto tgi Nhu vdy cd sy khac nhau vi cac logi
:bgnh vi$n 103 (2010 - 2013) benh pham phto benh phdm phto lap dugc vi khudn sinh
l§p dugc nhilu vi khuin sinh ESBL Id nudc ESBL d cdc bSnh vien, do tfty thugc vdo md
tilu - dich dudng sinh dye (32,5%), dich vit hinh benh tdt cfta mdi bgnh vign.
3.2. Xie djnh mfti: d^ nhgy cim vdi khing sinh ciia vi khuin sinh ESBL
3.2.1.Ty l | nhgy cam vdi khing sinh cua E. coli
Bing3.4. Tylf nhgy cam v&i khangslnh cua E. coli
Khing sinh

Cefoxitin (FOX)
41,6
Cefuroxim (CMX)
Cefotaxim (CTX)
84 100
 HMKH Y DUgC - K* N i a i 50 NAM N G A Y mUY£N THfi NG TRUdNG CAO O A N G Y THAI N G U Y £ N (1966-2016) %

Ceftriaxon (CRO) 0 0 0 0 84 100 •

Ceflazidim (CAZ) 0 0 0 0 84 100 •
Ticarcillin +
clavulanate
58 69 5 6 21 25 J
Cefopeiazone -i-
sulbactam
73 86,9 8 9,5 3 3.6 ' 1
Amikacin (AN) 55 65,4 5 6,0 24 28,6 1
Levofloxacin (LEV) 43 51,2 2 2,4 39 46,4 . j
Btog 3.4: Ty lg nhay cdm ciia E. coll vdi: cefoperazon -f- sulbactam (86,9%); neltin
(85%); ticarcillin + clavulanate (69%); amikacin (65,4%); levofloxacin (51,2%);
(54,8%). Ty IS khtog khtog suih cua E. coli tit cao vdi cac khtog sinh thugc nhdm p - lacu
nhu ceftroxim, ceftriaxon, cefotaxim, ceftazidtm (100%).
3.2.2. Ty l | nh^y cam vdi khing sinh cua Klebsiella
Bing 3.5. Ty If nhgy cdm vii khdng sinh cua Klebsiella
Khing sinh

Cefoxitin (FOX)
% %
Cefuroxim (CMX)
Cefotaxim (CTX) 25
Ceftriaxon (CRO) 25 100
Ceftazidim (CAZ) 25
Ticarcillin -i- clavulanate
Cefoperazone -f sulbactam 22
Amikacin (AN)
Levofloxacin (LEVi 36
Theo btog 3.5: Ty lg nh?y cdm cua 70% doi vdi gentamycin, ciprofloxacin;,1ren
Klebsiella vdi: cefopeiazon •^ sulbactam
40% dli vdi amoxicillin/acid clavulanic t
(88%); cefoxitin (72%); ticarcillin -i-
khtog dudi 10% doi vdi ertapenem. RiSni
davulanale (40%); amikacin (40%);
ddi vdi imipenem khtog Proleus 16,67%*-
levofloxacin (36%). Ty 1? khtog khtog sinh
chua od ti 1$ di khtog doi vdi EscherSt^
cua Klebsiella rat cao vdi cac khtog sinh
coli, Klebsiella, Enlerobacler.. [3]. Nghiit
lhu«c nhdm J lactam nhu cefiitoxim.
ceftriaxon, cefotaxmi, ceftazidim (100%). cftu cua Trin Do Htag tgi Bgnh vi^nfii
Kit qud nghito cuu cua chtog tdi cung phu khoa Cdn Tho (2012): ty 1^ vi khuiii sllli
hgp vdi nghiSn cuu cfta cdc tdc gia ttong vd ESBL cd ty Ig dl khtog khtog sinh cao hm
ngodi nudc. nhilu so vdi cdc vi khuin khdng sinh ESBU
ESBL
nhit Id vdi cdc khtog sinh nhu: ampici,—
Theo nghiSn cuu cua Phgm Thj Thu ciMl
cephalosporin v4 cefotaxime gin nhf
Hdng tgi bgnh vign Blnh Dto (2012) cho nh?|
100%, kl din 14 tetracycline v4 Bacttim,,
^ y ; ty lg vi khuto sinh ESBL khtog 100% •o-t
chftng sinh ESBL d l khtog muc dg cao'vi
dll ^d, khtog sinh nhdm cephalosporin, ttSn gentamycine (>70%), dl khtog trung btt

46
 Y H O C VlgT NAM TAP 449 • T H A N G 12 - SO DAC BlgT - 2016
~jdi ciprofloxacine (tu 39,2% din 59,2%) vd
•-oiic iJg dl khtog thip nhit la
;un03dcilliiie/acid clavulanic[2]. Theo
-~,<guyen Ddc Trung vd cs nghiin cftu tai Benh
•.•ien Da khoa Trung uong Thai NguySn vd
-Jgnh viln Trudng Dai Hoc Y dugc Thai
4
^ 3.2.3. Xie djnh nong do nc che toi thilu (MIC) ertapenem v i imipenem cua vi khuin
•iinh ESBL
; Bing 3.6. Nong do u-c chi toi thiln cna vi khuin sinh ESBL vdi ertapenem v i
-mipenem
Nhfn xit! Nong dg fte chi tdi thieu cua
ertapenem tft 0,25 din 2 pg/mL. Trong dd
chu yiu 14 ning dg 0,25 pg'mL chilm 81,8%
. Ning dg fte chi toi thilu (MIC) ertapenem
,.vi imipenem cfta 33 chtag vi khuin sinh
ESBL: vi khudn sinh ESBL khtog vdi
I imipenem (> 4 pg/ml) vdi 12.1% v4 9,1%,
I khtog vdi ertapenem (2 pg/ml).
Theo Hd Thi Thu Vto tgi bgnh vign 103,
• E. coli khtog imipenem 20%[5].Trin Do
Htag tgi benh vita da khoa Cin Tha, vi
khuin sinh ESBL cdn nhay cdm 100% vdi
imipenem[2]. Theo Shah Kinal (2012), thuc
hi§n xdc dinh MIC cua 53 chtog E. coll vd
Klebsiella tgi mgt Bgnh vita An Do cho kit
qud MIC ertapenem < 0,5 pg/mL[6].
Dilu ndy ctag hoto toto phft hgp vdi I
sl nghiSn cua cto cac tic gid ttong va ngodi
nudc. So vdi kSt qua cua Ttin Dd Htog thip
htm so vdi kSt qu4 cua chtog tdi. NguySn
nguyin (2014) cho kit qii4: cac chtag E. coli
vd K pneumoniae suih ESBL dSu H khtog
cac cephalosporin thS he 3 (ceftriaxone,
cefiiroxime, ceftazidime, cefotaxime) d mftc
do ca.[4].
nhto cd the do benh vito Vigt Due 14 bgnh
vign tgp trung nhieu benh nhto ndng hcm, tan
suit sft dtag cdc khtog sinh nhlu hon do dd
vi khuin khtog thudc vdi ty 16 cao hon. Dilu
ndy ctag ly gidi kit qua cua chung tdi ctog
toong ddng vdi kit qud nghiin cftu tai b^nh
vign 103.
IV, Kit LUiJN
4.1. Sir phan bo ciia vi khuan sinh
ESBL
- Sy phto b l cua vi khuin smh ESBL chu
ylu 14 £ coli chiim 73%, kiebsiella 22%,
Proleus 4%.
-Vi khuin smh ESBL thudng gjp d cac
khoa chto thuang, hdi sue cip cftu, phau
thuat gan mdt, phau thudt tilt nieu.
- Benh phdm phto lap vi khudn sinh
ESBL Id dich I bung - dich mat (35,6%),
dich cdc loai vit md - mft - dich vit ml
47

WtKH Y DUgC - KY NlSH 50 NAM NGAY TRUYDN T H O N G TliUdWG CAO B A H G Y T H A I HGUVeN |19S6-2016|
(313%), Dich phi qui - ddm (20%), nudc
tilu (8,7%) vd dich khac (4,4%).
4.2. Xie d|nh mirc do nhay cam vdi
khing sinh ciia vi khuan sinh ESBL
Ty lg nhgy cim cua E. coll vdi:
ertapenem (92,8%); cefopetazon -l- sulbactam
(86,9%); neltimicin (85%); ticarcillin +
clavulanate (69%); amikacin (65,4%);
levofloxacin (51,2%); cefoxitm (54,8%). Ty
1§ khdng khtog sinh cto E. coll rdt cao vdi
cic khtog smh thugc nhdm P - lactam nhu
cefiuoxim, ceftriaxon, cefotaxim, ceftazidim
(100%)"
Ty 1? nhay cam cua Klebsiella vdi:
ertapenem (96%); cefoperazon + sulbactam
(88%); cefoxitin (72%); ticarcillin -l-
davulanale (40%); amikacin (40%);
levofloxacin (36%); Ty IS khtog khtog sinh
cfta Klebsiella rdt cao vdi cic khtog sinh
thu^c nhdm
P - lactam nhu cefiuoxim, ceftriaxon,
cefotaxim. ceftazidim (100%), arapicillin
(96%).
- Nong dg fte cbl tii thiiu (MIC) cfta 33
chtog vi khuin sinh ESBL: Vi khuin sinh
ESBL khtog vdi imipenem (> 4 pg/ml) vdi
12,1% vd 9,1%, khtog vdi ertapenem (2
pg/ml).
V, KI^N NliHI
Thudng xuyln theo ddi ly 1^, mftc dg
nhgy cdm vdi khtog sinh cua vi khuin nhdt Id
cdc VI khuto sinh ESBL vi carbamapenem
decdhutog dilu tti phu hgp.
Vdi cic bgnh nhto nhilm khudn sinh
b ^ L cto cich ly va cd dung cy can thigp
rJQ YTHAI NGUYEHTl96t
Vdi cac blnh nhto nhiem khuin do i
khuin ESBL, dilu tri nhit thiit phai Ih
khtog sinh do.
TAI LIEU THAM KHAO
1, Tran Thj Nggc Anh (2011), "Nghien cihim
ntog sinh beta- lactamase phi rgng va liii
khang khtog sinh ciia mgt sl ttvc khu^
gram dm phto lip t^i bgnh vign Nhi Dong 2
tft 2007 din 2010", Lugn van Thgc sy Yhic,
Hgc vign Quto Y )j
2, Tran Bo HOng va CS (2013), "Nghien m
mgt sl trgc khuan gram dm sinh ben.
lactamase phi md rgng phan l§p t^i b?iili
vien da khoa Cin Tho ", Tgp chi ¥ Ape
TPHCM l4{2),tr6S. i
3, Phan Thj thu Hong vi CS (2012), "Khaosl
vi khuin tilt ESBL tsi bgnh vifn Blnh Ml'
Tap chi YHTPHCM. si 1 - igp 16. 2012.
4, Nguyin Die Trung vi CS (2013-2014), "D)t
dllm khing khtog sinh va kha ning sinh f.
lactamase ciia mgt sd chung E. coll %_.
Klebsiella pneumoniae t^i bgnh vi?n Dakh^'
trung uong Thai Nguyen vi b|nh Y|
Trudng Bjii hpc Y dugc Thii NguySn 4/2lil
- 4/2013", Tgp chi khoa hoc vi cong ii§
lis (20H).
5, Hi Thj Thu VSn (2011), "NghiSn cihi ty It
sg phta bl vi muc dp khang khing sinh l#
cic chiing enterobacteriaceae sinh bea-
lactamase pho rpng, carbamapenemase l|i ^.
bsnh vijn 103 tft 1/2010 den thdng 6/2013^] f
Luin van Thgc sp Y hgc, Hgc vign Quill Y
6, Shah Kinal, Mulaa Summaya A (2012),
"Susceptibilities of ESBL - producin
enterobacteriaceae to ertapenem, incropenm'.
and piperacillin tazobactam" Naliatt.
Journal of medical reseaeh. Volume 2 issue!
apr-June2012: 223-225.